'Morning after' pill still isn't easy to obtain

Aug. 21, 2013

Updated Aug. 22, 2013 2:38 p.m.

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"Plan B is safe and effective to prevent pregnancy. However, the main focus should always be on prevention, before it happens," said Dr. Katherine of Southern Orange County Pediatric Associates in Ladera Ranch. ED CRISOSTOMO, ORANGE COUNTY REGISTER

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PlanB One-Step, the morning-after pill, is now available across Orange County, without a prescription and with no age limit. KATE LUCAS, ORANGE COUNTY REGISTER

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"Plan B is safe and effective to prevent pregnancy. However the main focus should always be on prevention, before it happens," said Katherine Roberts, MD, FAAP, a pediatrician at Southern Orange County Pediatric Associates. ED CRISOSTOMO, ORANGE COUNTY REGISTER

"Plan B is safe and effective to prevent pregnancy. However, the main focus should always be on prevention, before it happens," said Dr. Katherine of Southern Orange County Pediatric Associates in Ladera Ranch. ED CRISOSTOMO, ORANGE COUNTY REGISTER

Where can I get Plan B?

A visit to several pharmacies in Orange County showed varying levels of access.

All major chain pharmacies surveyed had it, although not all out in the aisles. At a Walgreens on Irvine Boulevard in Irvine, Plan B One-Step was on the top shelf of Aisle 4, as well as behind the counter. At a Walgreens on El Toro Road in Lake Forest, there was an empty row on a shelf, and a spokeswoman said the store was waiting for the "proper display" to be shipped so it could be displayed in the aisle.

Pharmacies are not required to sell the product at all. Some smaller, independent pharmacies might not carry it, for lack of shelf space, unless there is a demand for it. Tustin Community Pharmacy did not have it in stock, but said it could order it and have it available next day.

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It took 12 years of legal, political and regulatory wrangling to make the morning-after pill available without a prescription and to women and girls of any age.

Yet it's still not what you'd call available – as in, easy to get, quickly, with no hoops to jump through.

The over-the-counter drug, whose brand name is Plan B One-Step, was expected to be on the shelves of the big retail pharmacies as of Aug. 1, according to its manufacturer, Teva Women's Health, a subsidiary of Israel-based Teva Pharmaceuticals. In a news release dated Aug. 7, the company said it was "now widely available in the aisles of major retailers nationwide with no age or point-of-sale restrictions."

There are challenges, however: Older boxes of Plan B One-Step, manufactured before the final court battle was decided in June, still must be kept behind the counter and can be sold only to those who have ID proving they're at least 17. Newer boxes with updated FDA labeling may be stocked on shelves, but many stores are keeping them locked in plastic "clamshell" containers, purportedly so they won't be shoplifted. Two generic versions of the drug are available, but they're behind the counter for the time being. They'll continue to carry the age-17 requirement until Teva's three-year period of exclusivity has expired.

"There's definitely a lot of confusion, both among consumers and retailers," says Jessica Arons, president and CEO of the Reproductive Health Technologies Project in Washington, D.C. "And that confusion is an unfortunate byproduct of the arduous process we went through to get emergency contraception approved over the counter."

Cost is another potential barrier. Plan B One-Step runs about $50 at most retailers, for just one pill. The two generics, My Way and One Choice, are about $10 cheaper, not as big a markdown as consumers of generics are used to.

This accumulation of obstacles could cause a delay in taking it. The manufacturer says the drug should be taken within 72 hours of unprotected sex (or failed contraception), but it's most effective when taken within 24 hours. Even having to ask a store clerk to open a case containing the box could make the buyer self-conscious.

"It's not like buying another product," says Kelly C. Cleland, a Princeton researcher and the executive director of the American Society for Emergency Contraception. "You've got this giant plastic box in your shopping cart, and it adds to the feeling that you're buying something you shouldn't be buying."

ROAD TO APPROVAL

The drug, with a medical name of levonorgestrel, delays ovulation. It was first approved by the FDA on July 28, 1999. Back then it was called simply Plan B, and it required taking two pills, 12 hours apart. The approval set in motion years of delays and acrimony. The drug evolved into one pill, Plan B One-Step, which was approved in 2009. The real flash point in the fight came Dec. 7, 2011, when the Obama administration overruled the FDA's approval of Teva's application to sell the drug over the counter, to women of any age.

The battle culminated June 10, 2013, when the government announced it would not appeal a federal judge's ruling striking down the age and point-of-sale restrictions of Plan B.

Opponents lamented the fact that, essentially, any girl of reproductive age could use the drug.

"It should be clear that Judge (Edward) Korman's decision to eliminate parents and doctors from discussions involving a child's sexual behavior and the administration of a serious drug is irresponsible and potentially dangerous," wrote Anna Higgins, director of the Center for Human Dignity with the Family Research Council.

DRUG SAFE, EFFECTIVE

Dr. Felice Gersh, an OB/GYN with Integrative Medical Group of Irvine, says the drug should be taken only as a last resort, and that the long-term health effects can't yet be known. But she adds that it's a safe, effective way to prevent unwanted pregnancies and abortions.

Gersh called teen girls “almost like a lost group,” because many have seen only a pediatrician growing up, not yet a gynecologist.

"So sometimes they're just really fending for themselves, and if overall they're healthy, they really may not even go to doctors at all," she says. "So this can be, of course, a problem, if they're becoming sexually active and no one has really educated them, other than in school, where they're not providing anything."

The Orange County Department of Education says it will be up to individual schools and districts to decide whether to make Plan B part of a health curriculum.

"I don't think keeping kids in the dark on what forms of birth control are available will help them at all, and I also don't think, on the other end, it's going to change their sexual practices. What this will do is help prevent pregnancies and prevent STDs."

MONITORING ACCESS

Arons said pharmacies have had plenty of time to learn the rules, and to stock the product on their shelves. "Really, it's uncrear to us why there might be any hesitation to put it on the shelves and make it ready for people when they need it," she said.

Her group has created the ETOTC (for Emergency Contraception Over the Counter) Tumblr for the public to get information, as well as give it to pharmacists and employees who aren't yet up to speed. Users also can share photos of places that sell the drug, as well as those that don't. The site had received information about Oklahoma's law restricting access to Plan B One-Step. A judge has temporarily blocked the law.

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